Posted 1 year ago on Dec. 2, 2013, 1:11 p.m. EST by LeoYo
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Iceland has a universal health care system that is administered by The Ministry of Welfare (Icelandic: Velferðarráðuneytið) and paid for mostly by taxes (85%) and to a lesser extent by service fees (15%). Unlike most developed nations, there are no private hospitals, and private insurance is practically nonexistent.

If a population of 300,000 can provide universal health care for themselves, members among a population of 300,000,000 can certainly provide health care for themselves without involving all those who don't want to participate.

Trying to impose universal health care on those who don't want it only puts such a health care system at risk when those who don't want it periodically come to power. A national mutual health insurance company structured upon the model of a national single payer health care system could provide relief for millions while remaining forever outside the reach of those opposed to collective health care.

The Affordable Care Act continues to plow ahead, despite Republican attempts to fight it at every turn. What is unfolding in front of us is nothing short of spectacular. The problems with healthcare.gov are slowly being resolved which is helping more and more people sign up for affordable healthcare, many for the first time in their life. The law provides so much more than that, including standards for even the lowest level plans, protections for young adults 26 and younger, and the elimination of pre-existing plans. Of course, you will not hear the success stories on the news, because those stories are not nearly as sexy as the “Obama Lied” slogan they are so fond of.

The biggest downside of the ACA is the reliance on the private insurance industry. It does not have to be this way, however. There is yet another provision in the Affordable Care Act that can open the door for states to institute their own single-payer healthcare system. Other states have a public option, especially for those below a certain income level, but no state had instituted a true single-payer system. All of this has changed thanks to President Obama and the Affordable Care Act.

Vermont—Home of Ben and Jerry’s, Maple Syrup, Bernie Sanders and the first state to pass marriage equality. Now, Vermont will be known for something that will impact every resident in the state.
The ACA provided states with federal funds to institute a Medicaid expansion. The states chose to expand the program also were able to set up their own state exchanges, which were relatively free from the problems the federal site had. Vermont decided to take it a step further by setting up their very own single payer system.

The slogan of the program: Everybody in, nobody out.

The program will be fully operational by 2017, and will be funded through Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. In exchange, there will be no more premiums, deductibles, copay’s, hospital bills or anything else aimed at making insurance companies a profit. Further, all hospitals and healthcare providers will now be nonprofit.

This system will provide an instant boost the state economy. On the one side, you have workers that no longer have to worry about paying medical costs or a monthly premium and are able to use that money for other things. On the other side, you have the burden of paying insurance taken off of the employers side, who will be able to use the saved money to provide a better wage and/or reinvest in their company through updated infrastructure and added jobs. It is a win-win solution.

To make sure that it is done right the first time, Vermont brought in a specialist who knows a thing or two about setting up a single-payer system.

Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings.

Many like to say that the United States has the best healthcare system in the world. The problem is we don’t. Not even close. In fact, the only way you can get the best healthcare in the world, is if you are willing and able to pay for it. The United States can and must do better for its people.

Costs have to be held down — there is no reason why the U.S. has to pay twice the amount per capita as the next most costly system in the world (Norway’s), and still not cover millions of its citizens. A Harvard Medical School study states that 45,000 Americans die each year from treatable diseases because they cannot afford to get treatment.

45,000 Americans die every single year because they cannot afford treatment, are you ready for that? That is 15 times the amount of people that died during the September 11, 2001, attacks, or perhaps for you Righty’s out there you would rather see it put this way, 11,250 times the amount of people that died in the Benghazi attack. That equals 5 Americans that die every hour, of every day, of every year because of a preventable illness that was not taken care of due to lack of access and means.

Even once the Affordable Care Act wrinkles are ironed out, which they will be, and every America is covered, which will happen, that will not change the fact that all of this is being driven by a for-profit system by companies that only care about their bottom line. Despite rules in the ACA which prevent insurance companies from absolutely gouging their customers, insurance companies are not exactly know for their ethical behavior.

A single-payer system would all but eliminate anybody dying unnecessarily due to lack of access to healthcare. Our Declaration of Independence states, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” How can somebody have life and happiness, without their health? Despite the glaring hypocrisy of rich, white males who owned slaves stating all men are created equal, we have come a long way from 1776. Yet when it comes to the very basic need, we are left to the whim of a business. Single-payer is inevitable, and the ACA is a giant step in that direction. We need must hold our officials to a higher standard which will get us there faster. 40,000 people a year is absolutely unacceptable. Vermont saw the writings on the wall. Will the rest of us?

Video

Bernie Sanders on MSNBC discussing his state’s new single-payer system.

Now there's no more excuse. Americans can push for single-payer health care in every state and actually establish it directly through ballot initiative in 24 of the states. The insurance companies would be defeated and have no profit making part in it. It is simply dependent upon the will of the People to make it happen IF it's really what Americans want. The people in Vermont certainly do. What about the rest of America? Bringing about single-payer health care in all of the states is bringing about universal health care. Federal implementation would be inevitable with universal state implementation.

Bringing about the establishment of single-payer universal health care is now a choice for the American people.

Following the lead of tiny Vermont, advocates of Medicare for All are developing state campaigns to win health care that eliminates insurance companies and covers everyone.

Beginning in 2017, the Affordable Care Act, or Obamacare, allows the federal government to grant a waiver to any state that wants to introduce “innovations”—provided the coverage is at least as comprehensive, extensive, and affordable as coverage under the ACA.

Since a “single-payer”-style state system would easily meet those criteria, activists are hoping for a path forward state by state.

Medicare, the government plan for those 65 and over, is “single-payer” because all care is paid out of one public fund, which keeps overhead down to 3 percent. By contrast, private insurance drains 10 to 30 percent of health care dollars.

While state single-payer systems couldn’t capture all the efficiencies that a national Medicare for All system would, a well-constructed state plan could come pretty close. And it would be “everybody in, nobody out.”

The win came only after “25 years of legislative bills didn’t work,” said Amanda Sheppard, a board member of the Vermont Workers Center and a union home care worker. So instead of pinning their hopes on lobbying, activists focused on building a grassroots coalition with strong labor support.

Vermonters held scores of town meetings to educate and create a groundswell. When residents testified to the legislature, “our most powerful organizing tool was to get people to tell their own stories about the injustices of the for-profit health care system,” Sheppard said.

This organizing approach came in handy when a legislative compromise sought to exclude undocumented immigrants from coverage. Thousands converged on the statehouse on short notice, and the provision was dropped.

Sheppard said the future of Green Mountain Care, which is still far from being implemented, depends on this labor-community coalition. Advocates are grappling with complex financing issues, and national corporate interests are pouring millions into the state to undermine the program.

Meanwhile, nearby, “we’re following the path blazed by our brothers and sisters in Vermont,” said Maine AFL-CIO President Don Berry.

A majority of Maine’s legislature supports single-payer legislation. Although anti-labor Governor Paul LePage is blocking all reform initiatives, health care advocates hope to pitch him out in November.

Labor has allied with the Maine People’s Alliance, physicians, and other community and faith groups in a campaign to emphasize, as Vermonters did, that health care is a fundamental human right.

Pushes and Pulls

Advocates are turning to state campaigns partly because the political climate in Washington, D.C. has made imminent progress on a federal Medicare for All bill “inconceivable,” according to one long-time activist.

The practicality of single-payer shouldn’t even be up for debate. Maintaining thousands of profitable insurance companies as paper-pushing gatekeepers is unbearably expensive.

Worse, they have a toxic business model: the more health care they deny, the more money they make. If money from premiums were diverted to care, there’d be plenty of care to go around—for the same price we’re paying now.

But insurance companies would need to be euthanized. Naturally, they spend lots of money to defeat any such effort. Even in Vermont, which has only one private insurance company, a fierce battle is underway over the law’s implementation.

Negative aspects of Obamacare have also knocked state organizing into gear. The messy rollout of the “exchange” in Oregon has left many looking for a simpler system, said Lee Mercer, a board member of Health Care for All Oregon.

The coalition is hosting town meetings, talks by experts, and film showings all over Oregon, including conservative rural areas, Mercer said. The “Health Care Movie” is a popular draw. If they have enough momentum, volunteers, and money, he said, they may place a referendum on the 2016 ballot.

The Oregon coalition has 800 affiliates, including dozens of chapters around the state and many big unions: AFSCME, the Communications Workers, both teachers unions, the state’s two Service Employees locals, Teamsters.

Building trades have been less enthusiastic so far, Mercer said, though nationally construction workers have shown plenty of interest in single-payer.

The Plumbers and Pipefitters (UA) have repeatedly affirmed support for Congressman John Conyers’ federal Medicare for All bill. A Canadian member testified at the union’s convention in 2011, commending Canada’s single-payer system.

Getting a heart valve replaced, said delegate John McKnight, “cost me zero. But as a Canadian citizen, it did cost me through the income tax system of our country. Taxation can be a very good thing, and it gave us health care.”

Taft-Hartley Trouble

Obamacare is driving many unions up the wall with its mistreatment of Taft-Hartley plans, the multi-employer insurance pools used by janitors, Teamsters, and grocery, hotel, and construction workers. These plans have long served to guarantee health care to union workforces with many employers, and to construction trades workers who often find themselves between jobs.

In a scathing March report called "The Irony of ObamaCare: Making Inequality Worse," the hotel workers union UNITE HERE denounced the ACA’s $965 billion in subsidies to commercial insurance companies as “one of the largest transfers of public wealth to private hands ever.”

Although they are nonprofit, Taft-Hartley plans are excluded from the subsidies. The exclusion defies logic, say union fund trustees. It seems the administration would rather subsidize private insurers who provide more expensive coverage on the exchanges than help existing Taft-Hartley plans continue to cover union members.

In some cases this crisis has translated into support for single-payer, which would be “like collective bargaining for the entire population,” said Gene Carroll of the New York State AFL-CIO’s training center.

He spoke to a crowd of union members, many of them administrators or trustees of Taft-Hartley plans, at an April health care summit sponsored by New York’s LaborPress. Activists there said Obamacare’s incentives to employers to drop insurance are undermining collective bargaining.

Bridie Bugeja helps members navigate their coverage at Local 338 of the Retail Workers, RWDSU. “Part-time workers have lost coverage completely,” she said.

California Switch

There is one positive reason the ACA could help push single payer: it has created big federal subsidies, the ones now going to private insurers, that could be used to help any state run its own system.

At the April Labor Notes Conference, union representatives from Vermont, Maine, Illinois, Washington, New York, and California talked about the status of their single-payer organizing.

California would be the biggest prize. Twice when Republican Arnold Schwarzenegger was governor, both houses of the legislature passed single-payer legislation, only to have him veto it.

Now, despite Democrat Jerry Brown as governor and Democratic supermajorities in both houses, advocates can’t even get a bill submitted. Legislators who enjoyed no-cost brownie points from their constituents for voting for single-payer have become born-again skeptics.

“This has been a real learning experience,” said Martha Kuhl, secretary-treasurer of the California Nurses Association. Her union helped launch the Campaign for a Healthy California, which aims to institute single payer by popular initiative, perhaps as early as 2016.

Unlike minimum-wage initiatives, which usually pass when taken to the voters, single-payer referenda have not fared well. California and Oregon tried in 1994 and 2002 respectively, but couldn’t get even 30 percent of the vote.

Still, California unions built a successful organizing model in 2012, when they campaigned for a proposition that increased taxes on the rich to fund education, and against another that would have paralyzed unions’ political action. Unions pulled out all the stops, spending massively and dedicating unprecedented staff time. In Oregon in 2010, voters passed two tax-the-rich measures.

New York’s single-payer bill, Gottfried-Perkins, has majority support in the state assembly, said New York State Nurses Vice President Marva Wade. A number of large and influential state unions, including 1199 SEIU, have recently joined NYSNA in supporting it.

“But Governor Cuomo hasn’t lifted a finger to support it, and the state senate is a real nest of vipers,” Wade said. “We’re going to need a strong movement to get this job done.”

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The U.S. health care system is the most expensive in the world and covers far fewer people than health care systems in other rich countries.

Joining us in-studio to discuss all of this is Dr. David Himmelstein. He's a primary care doctor and professor of public health at the City University of New York. He cofounded Physicians for a National Health Program.

Thanks for joining us, Doctor.

DR. DAVID HIMMELSTEIN, PROF. PUBLIC HEALTH, CITY UNIVERSITY OF NEW YORK: Thanks for having me.

DESVARIEUX: So let's just start off. Off the bat, can you just explain how the U.S. has the most costly health care system, and yet we don't cover everyone? How is this even possible?

HIMMELSTEIN: Well, we have an enormous number of people making profits and middlemen in the system. So our insurance companies, for every $1 we pay in, we get about $0.86 worth of care out. Fourteen cents of every dollar stays with the insurance firms, doesn't buy any health care. And we have enormous numbers of for-profit hospitals, dialysis companies, nursing homes, a lot of money being made in the health care system, not to delivering the care that people need, but actually supporting corporate profits and interests.

DESVARIEUX: So let's talk about that this system that we have now and what we're hoping to implement, which is Obamacare. Do you think that this addresses the root problems at all of what's happening?

HIMMELSTEIN: Well, Obamacare is really a compromise with the insurance industry and the drug industry, the people who've been running the health care system into the ground. So it would dump $1 trillion into the private insurance industry over the next ten years trying to get them to behave better. And it may get some people additional coverage, and expanding Medicaid, part of the Obamacare program, is probably a good thing. But it doesn't fundamentally address the problems in our health care system. And, in fact, the $1 trillion we'll give to private insurance companies in a way puts them in a stronger position.

DESVARIEUX: But, Dr. Himmelstein, there are people that are saying that we know Obamacare is not perfect. However, it is a path to eventually getting single-payer. What's your response to that?

HIMMELSTEIN: Well, we'll have to see whether that's true. I'm concerned that strengthening the private insurance industry may not be the right way to move towards eliminating the private health insurance industry, which is what we need to do to have a decent health care system. I mean, in Canada, insurance takes about 1 percent of running the system; in our system, as I said, about $0.14 of every dollar for insurance. And these new exchanges which are being set up, which are really just a sales force to sell private insurance, they're taking another 3 percent, another $0.03 of every $1, to run them. So we're spending an enormous amount of money pumping more administration, more bureaucracy into the system, and strengthening the private insurance industry. I worry that that doesn't lead us in the direction we need to go.

DESVARIEUX: Okay. Let's turn the corner here and talk about how we can actually implement a single-payer system in the United States, 'cause there are some people who are skeptical saying, you know, it works in Canada, it works in Denmark, but it's not going to work in the United States. Can you just lay out a framework of how single-payer could work in the U.S.?

HIMMELSTEIN: Yeah. Well, you could expand Medicare to cover everybody in this country, upgrade Medicare coverage. Medicare at present takes only about $0.02 to administer versus that $0.14 in the private insurance industry. And if you expanded Medicare to everybody, you would have that $0.12 on the dollar left over to actually improve the coverage. And you could give first-dollar coverage to everybody in the United States if you did a Medicare program for everybody and cut out some of the bureaucracy that the insurers now make hospitals and doctors put up with.

So if you go to a hospital in Canada, there's no billing office in most hospitals, because every Canadian has the same coverage and a hospital gets paid the way a fire department gets paid in our country. They get one check a month to run the entire operation. There's no need to figure out who got each Band-Aid and aspirin tablet. You go to a typical American hospital, there are 150 people doing nothing but billing. And we ought to put those people to work doing useful things, help taking care of people, and put those resources to actually making health care work in our country rather than shuffling papers and enforcing inequality, enforcing that some people have the right to good health care and many others don't.

DESVARIEUX: I can attest to that billing, 'cause my mom is actually on in a registered nurse, and much of her time is dealing with billing, 'cause she does home care.

But I want to talk a little bit more about the Canadian system. You mentioned that this would be a sort of model a bit. You were referring to it. But there are people that criticize it, saying, oh, there are so many long lines, and the wait time is impossible at times. What is your response?

HIMMELSTEIN: Well, Canada spends about half as much per person on health care as we do in this country. And if we were willing to take Canada's system and double the amount of funding, we would have not just better care than they have in Canada, but much, much better care than we have here in the United States. And we know from comparative studies in the two countries that the average Canadian gets care as good as the average insured American today. But you take double the money they spend in Canada, we ought to be able to do very much better than that for every American.

DESVARIEUX: And you also claim--I know I read a little bit of your work that this [incompr.] save money not only for the health care recipients, but also for the providers. Can you explain that a bit more?

HIMMELSTEIN: Well, for providers, I mean, the average doctor is spending about 20 percent of their time on nothing but billing and bureaucracy. So we'd free up tremendous amount of time of doctors and nurses--you mentioned your mother--to actually do the work that we're trained to do rather than checking the boxes and fighting with insurance companies. And that provides the resources we need, the extra time we need to take care of people, to take care of people who are currently uninsured.

The other thing we need to do is stop doing some of the useless and even harmful stuff that doctors are doing today because there's money in it. So we know that a lot of the operations done today actually don't to patients any good, that probably something like one out of five of the cardiac stents that are put in place are done not because they do patients any good but because there's money to be made doing them. So we need to take the profit motive out of the health care system as well.

DESVARIEUX: Alright. Dr. Himmelstein, thank you so much for joining us.

To make that work, you'd have to turn away those who don't join the collective when they need medical care and have no insurance, otherwise it won't work, and that would be inhumane. That is why universal healthcare needs to be universal.

You don't have to turn away anyone as anyone can join at anytime. However, anyone who joined upon immediate need would be contractually obligated to remain upon their needs being satisfied until the cost of their needs had been paid in full.

It's not so much that Obama "sold us out" to a powerful constituency, but that he picked the wrong powerful constituency. A quick look at the financial details reveals that health insurance nationalization was always the real "path of least resistance."

Back in March 2009, leaks from the White House made it clear that a single-payer health insurance system was “off the table” as an option for health care reform. By doing so, the President had ruled out the simplest and most obvious reform of the disaster that is US healthcare. Instituting single-payer would have meant putting US health insurance companies out of business and extending the existing Medicare or Medicaid to the entire population. Instead, over the following weeks the outlines of the bloated monstrosity known as Obamacare emerged; an impossibly complicated Rube Goldberg contraption, badly designed, incompetently executed, and whose intended beneficiaries increasingly seem to hate.

The decision to abandon the nationalization of perhaps the most unpopular companies in the US is correctly attributed to the fundamental conservatism of the Obama White House, and its unwillingness to take on the health insurers, pharmaceutical companies, or any interest group willing and able to spend millions lobbying, hiring former politicians, and donating to campaigns. Obama’s “wimpiness,” his need to always take the path of least resistance, became common tropes among the American left. Obamacare, liberals claim, is the best possible reform that could’ve been wrangled out of the health insurance industry.

But were the many backroom deals that make up Obamacare really an easier alternative to nationalization? A look at the financial details reveals the opposite conclusion. In strictly financial terms, nationalization would have been the easiest way forward, costing relatively little and delivering immediate savings while making access to health care truly universal. Politically, Obama could have counted on the support of a unlikely ally of progressive causes: health insurance shareholders, the theoretical owners of those very companies who would have been relieved of their then-dubious investments with a huge payout.

As of the end of 2008, the private insurance market covered 60 percent of the US population. For-profit insurers accounted for a large and growing share. The top five insurers accounted for 60 percent of the market — all but one of them for-profit companies. Absent a Bolshevik revolution, implementing a single-payer system would have required proper compensation for the owners of these institutions for their loss of future income — shareholders in the case of the for-profit insurers and, allegedly, the supposed policyholders in the case of most non-profits.

How much compensation? Well, in mid-2009, the total market capitalization of four out of the five top health insurers (the fifth is a nonprofit) amounted to about $60 billion. By then, the stock market had already rebounded nicely from the lows of the crisis, and the uncertainty over Obamacare had largely dissipated, so these were not particularly depressed valuations. Extrapolating this valuation to the rest of the health insurers would have a put a price tag of about $120 billion on the whole racket.

This means that buying out the entire health insurance industry at an enormously generous premium of, say, 100 percent, would have cost the Treasury $240 billion – about 2 percent of 2009 gross domestic product. And this figure is highly inflated —premiums for buying out well-established companies rarely exceed 50 percent and are usually closer to 20 percent. Also, I am valuing the dubious claims of non-profit policyholders on par with the more vigorously-enforced property rights of for-profit shareholders.

Other than the big smiles on the faces of health insurer shareholders across the country, what would have been the US Treasury’s payoff for writing a $240 billion check? Once again, the numbers are simple, and startling. US private insurance, whether for-profit or otherwise, may well be the most wasteful bureaucracy in human history, making the old Gosplan office look like a scrappy startup by comparison. Estimates of pure administrative waste range anywhere from 0.75 percent to 2.6 percent of total US economic output.
Extrapolating again from the biggest four for-profit insurers, in 2008, the industry as a whole claimed to spend 18.5 percent of the premiums it collected on things other than payments to providers. (The other 81.5% that is spent paying for actual care is known as medical loss ratio. Keeping this ratio down is a health insurer CEO’s top priority.) Medicare, by contrast, spends just 2 percent. The difference amounts to $130 billion, to which we must add the compliance costs the private insurers impose on health care providers — $28 billion, according to Health Affairs. The costs incurred by consumers are difficult to measure, although very real to anyone who’s spent an afternoon on the phone with a health insurance rep.

So, to recap, nationalization of the health insurance industry in 2009 would have cost no more (and almost certainly a lot less) than $240 billion. The savings in waste resulting from replacing the health insurance racket with an extension of Medicare would have resulted in no less than $158 billion a year. That’s an annualized return on investment of 66 percent. The entire operation would have paid for itself in less than 18 months, and after that, an eternity of administrative efficiency for free. And, of course, happy shareholders.
There would have been nothing exceptional about the arrangement, either. Examples abound of states buying out private shareholders on mutually agreeable terms. The British takeover of the “commanding heights” of the economy after World War II is perhaps the best known, but there have also been potash miners in Canada, New Zealand’s railroads, and Swedish ore producers among others. None of these cases were precursors to the Gulag.
In fact, in most of those cases it was the taxpayer who ended up getting fleeced, buying lemons at inflated prices. That would not have been an issue in this case – we’d have been going in knowing that we’re buying lemons.[MU2] After the deal closed, there would have been very little to do beyond shutting down operations, selling the buildings, and auctioning off the furniture. Everybody wins.
So what would make a self-described market-lover like Obama take such an obvious solution off the table before the discussions even began? As it turns out, Obama is a fan of a very specific kind of market – the kind of complicated, opaque market full of rules, moving parts, variables, exceptions, and complexities that generate lots of opportunities for rent extraction.

Since one person’s waste is another’s income, it is useful to look at the $130 billion (closer to $150 billion today) not so much as waste but as rent extraction. Rent extraction by whom? A look at private insurers’ financial statements sheds some light.

In 2007, the adjusted net profit margin of the average health policy amounted to just 0.6 percent (adjusted to account for the fact that many large employers self-insure, and simply pay an insurer to handle the administration of the plan; the insurer then reports only the fee paid by the employer as revenue, which skews their published profit margins upwards). Out of every $100 paid in premiums to a private insurer, the net profit extracted by its putative owner was just sixty cents. This may not be the appropriate venue to shed a tear for the poor anonymous shareholder, but it is clear that she did not exactly have a privileged place at the trough. Of all the loot extracted by the health insurance companies she invested in, just 4 percent ended up in her pocket.

Where does the rest go? Mostly, salaries for the industry’s nearly half a million employees, who get paid on average 46 percent more than the typical American worker. Health care CEO pay is the highest among all sectors of the economy, and insurance executives are the highest paid of all. United HealthCare’s CEO extracted for himself a very nice package of $42 million in 2011, and the average among the Big Four for-profit insurers was $14.1 million. By contrast, poor old Lloyd Blankfein of Goldman Sachs took home a mere $9 million.

The picture that emerges of health insurance rent extraction is that of college-educated managers in the middle; at the top, a miasma of the impeccably credentialed and connected executives, consultants, lobbyists and PR hacks that make up the backbone of post-industrial America’s upper echelon. Instead of an Andrew Carnegie, we get a hundred Tom Daschles. Except this time, no libraries, just ten thousand MBAs droning on in front of a Powerpoint slideshow – forever. Not exactly an improvement.

So what would be the costs if we had a president willing to nationalize health care now that Obamacare is the law of the land? Since 2009, when single-payer was taken off the table, the stock market has been lifted by the Federal Reserve’s desperate attempts to compensate for fiscal austerity and public and private disinvestment. The Treasury check would have to be bigger today, perhaps on the order of $500 billion – much less if the payoff to shareholders went from colossal to merely enormous, for instance. The public’s return on investment would still be over 30 percent.
The current system is mind-bogglingly wasteful. Its elimination would free up so many resources that a huge payoff for shareholders can be considered almost as an afterthought. However, the half-million people who currently work in the industry would have to seek gainful employment. That would include thousands of seven-figure executives, lobbyists, consultants and PR hacks. Such a tragedy will not unfold on Obama’s watch.

Healthcare needs to be single-payer because it's the most efficient, and not-for-profit, because it's expensive enough and it's a human right and people should come before profit. Until these two feats are met we will continue to have a messy, inefficient, ultra-expensive healthcare system.

Heh - and the propaganda machines try to get people to worry about an ACA death panel. That is what for profit health care is. A death panel for those with pre-existing conditions as they are not gonna get insurance and the hospitals are gonna say no ins no service.

The US does not have a health insurance problem. It has a health care cost problem – the uninsured are a symptom, not the illness itself. The parasitism of the actual health insurance companies is just more obvious than others. But from overpaid doctors, to usurious hospitals that charge $500 for a stitch, to snake oil-peddling pharmaceutical companies charging thousands a year for dubious treatments, there are simply too many people collecting too much money just because they can.

Unfortunately for the rest of us, they all seem to have a very good friend in the White House.

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In a recent online post for the Roosevelt Institute, the economics commentator Mike Konczal said most of what needs to be said about the underlying sources of the Affordable Care Act's complexity, which in turn set the stage for the current tech problems. Basically, Obamacare is not complicated because government social insurance programs have to be complicated: Neither Social Security nor Medicare is complex in structure. As Mr. Konczal wrote, it's complicated because political constraints made a straightforward single-payer system unachievable.

It's been clear all along that the Affordable Care Act sets up a sort of Rube Goldberg device: a complicated system that in the end is supposed to more or less simulate the results of single-payer, but keeping private insurance companies in the mix and holding down the headline amount of government outlays through means-testing. This doesn't make it unworkable: State exchanges are working, and healthcare.gov will probably get fixed before the whole thing kicks in. But it did make a botched rollout much more likely.
So Mr. Konczal is right to say that the implementation problems aren't revealing problems with the idea of social insurance; they're revealing the price we pay for insisting on keeping insurance companies in the mix, when they serve little useful purpose.

Does this mean that liberals should have insisted on single-payer or nothing? No. Single-payer wasn't going to happen — partly because of the insurance lobby's power, partly because voters wouldn't have gone for a system that took away their existing coverage and replaced it with the unknown. Yes, Obamacare is a somewhat awkward kludge, but if that's what it took to cover the uninsured, so be it.

And although the botched rollout is infuriating — count me among those who believe that liberals best serve their own cause by admitting that, and not trying to cover for the botch — the odds remain high that this will work, and make America a much better place.

Borscht Belt Republicans

Has anyone else noticed how much the G.O.P. position on Obamacare resembles the classic borscht belt joke about the two ladies at a Catskills resort?

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Paul Krugman joined The New York Times in 1999 as a columnist on the Op-Ed page and continues as a professor of economics and international affairs at Princeton University. He was awarded the Nobel in economic science in 2008. Mr Krugman is the author or editor of 20 books and more than 200 papers in professional journals and edited volumes, including "The Return of Depression Economics" (2008) and "The Conscience of a Liberal" (2007).

Police in Iceland killed a person for the first time in the nation’s history after they responded to shots fired at officers on Monday.

Two officers were fired on after going to an apartment in the country’s capital Reykjavik, police said in a statement. Like most of the country’s police force, they were unarmed as they investigated reports of a “loud bang” at around 3 p.m. local time (10 a.m. ET).

When a SWAT team arrived the man again fired on the officers, hitting one of them and sending him flying down the stairs, the statement added. It did not reveal the condition of the officer, but said the man then began firing through a window at them.

The team then entered the apartment and shot the man, before rushing him to hospital, the statement said. He was pronounced dead at the scene. Police said they regretted the incident and wished to express sympathy to the man’s family.

Icelandic website Visir later named the man as Sigrid Oscar Jónasdóttur and his sister Sigridur Jónasdóttir blamed poor health care for the mentally ill for the man’s death. “There are no resources for these people,” she told the site.

Iceland, with a population of around 320,000, has a low crime rate and gun violence is extremely rare.

In response to regular reports of atrocities by US soldiers, drone controllers, pilots and interrogators, the White House routinely tries to help. Every president promises to honor our armed forces and says ours is the finest military of all, etc. At last year’s Veterans’ Day ceremony, president fill-in-the-blank boasted, “America is and always will be the greatest nation on Earth.” This Nov. 11th, Mr. Obama said that since 9/11 the US is “defining one of the greatest generations of military service this country has ever produced,” and, of course,“[W]e have the best-led, best-trained, best-equipped military in the world.”
Really? On Veterans’ Day 2001, one headline blared: “American Soldier is Convicted of Killing Afghan Civilians for Sport.” US aggression, occupation, torture of prisoners, massacres, drone attacks, offshore penal colonies and sexual assaults against our own service members, take the luster from our official self-image of ‘exceptionality.’

In a bold invitation, Human Rights Watch has called on 154 parties to the UN Convention on Torture to bring charges against US officials under explicit language in the treaty, ratified by the US in 1994. The treaty requires such action when reputable allegations are not prosecuted by the accused governments, and ours doesn’t need any more evidence, just some of which may be found in these mainstream US media stories:

Atrocities against people of occupied or targeted countries aren’t the only ones accumulating. According to a July 2012 report by the Pentagon, over 25,000 sexual assaults occurred in fiscal year 2012, a 37 percent increase from FY 2011. About “500 men and women were assaulted each week last year,” USA Today reported July 25. See: “Reports of Military Sexual Assault Rise Sharply,” NY Times, Nov. 7; & “Sexual Assaults in Military Raise Alarm: 26,000 Cases Last Year,” May 7, 2013.

Throughout the Army, Navy, Air Force and Marines, according to the Pentagon, 74 percent of females report one or more barriers to reporting sexual assault. In addition, 62 percent of victims who reported sexual assault indicated they experienced some form of retaliation. This is why, according to US Sen. Tammy Baldwin, D-Wisc., more than 85 percent of all military sexual assaults go unreported. In fact, Sen. Baldwin says, “overall rates of reporting dropped from 13.5 percent in 2011 to 9.8 percent in 2012.”

In view of the staggering numbers, and to help end the cover-up and suppression of sexual assault reporting, US Sen. Kirsten Gillibrand, D-NY, has proposed removing investigation and disposal of such allegations from the military chain of command and place these cases with military prosecutors. Currently, commanders — superior to victims and perpetrators — decide whether or not to prosecute an accused G.I. Commanders even have the power to reduce or overturn a judge or jury’s conviction.

Gillibrand’s Military Justice Improvement Act of 2013, S. 967, would give military prosecutors, instead of commanders, the independent authority to decide whether or not felony cases go to trial. The proposalhas earned broad bipartisan support. It would reform the Code of Military Justice to make the system independent at the felony level.

A related bill, the Military Sexual Assault Prevention Act — S. 548 —sponsored by Sen.s Amy Klobuchar, D-MN, and Lisa Murkowski, R-Alaska, would prevent those convicted of sexual crimes from serving in the military, improve tracking and review of sexual assault claims in the military, and help ensure victims have access to criminal justice.

Presidential speeches can’t permanently obscure our record of military outrages. Some Congressional reform could at least confront the ones committed against women in uniform.

Missiles fired by a U.S. drone slammed into a convoy of vehicles traveling to a wedding party in central Yemen on Thursday, killing at least 13 people, Yemeni security officials said.

The officials said the attack took place in the city of Radda, the capital of Bayda province, and left charred bodies and burnt out cars on the road. The city, a stronghold of al Qaeda militants, witnessed deadly clashes early last year between armed tribesmen backed by the military and al Qaeda gunmen in an attempt to drive them out of the city.

There were no immediate details on who was killed in the strike, and there were conflicting reports about whether there were militants traveling with the wedding convoy.

A military official said initial information indicated the drone mistook the wedding party for an al Qaeda convoy. He said tribesmen known to the villagers were among the dead.

One of the three security officials, however, said al Qaeda militants were suspected to have been traveling with the wedding convoy.
While the U.S. acknowledges its drone program in Yemen, it does not usually talk about individual strikes.

If further investigations determine that the victims were all civilians, the attack could fuel an outburst of anger against the United States and the government in Sanaa among a Yemeni public already opposed to the U.S. drone strikes.

Civilian deaths have bred resentments on a local level, sometimes undermining U.S. efforts to turn the public against the militants. The backlash in Yemen is still not as large as in Pakistan, where there is heavy pressure on the government to force limits on strikes — but public calls for a halt to strikes are starting to emerge.

In October, two U.N. human rights investigators called for more transparency from the United States and other countries about their drone programs, saying their secrecy is the biggest obstacle to determining the civilian toll of such strikes.

The missile attacks in Yemen are part of a joint U.S.-Yemeni campaign against al Qaeda in the Arabian Peninsula, which Washington has called the most dangerous branch of the global terrorist network.

Thursday's drone strike is the second since a massive car bombing and coordinated assault on Yemen's military headquarters killed 56 people, including foreigners. Al Qaeda claimed responsibility for the attack, saying it was retaliation for U.S. drone strikes that have killed dozens of the group's leaders.